Cervical Intraepithelial Neoplasia (CIN)

What is cervical intraepithelial neoplasia?

Cervical intraepithelial neoplasia (CIN) is an abnormal growth of cells on the cervix. The cervix is the lower part of the uterus that opens into the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus.

CIN is not cancer, but it can become cancer of the cervix if it is not treated.

How does it occur?

You have a greater risk for CIN if:

• You have an HPV infection (human papillomavirus), which is the most common cause of CIN.
• You have had more than 1 sex partner.
• Your sex partner has been sexually active with other partners.
• You had sexual intercourse before the age of 18.
• You smoke.
• You were exposed to DES (diethylstilbestrol - a medication given to women to prevent miscarriage) when your mother was pregnant.
• You have a weakened immune system; for example, because you are taking immunosuppressive drugs, or you have AIDS.
• You have had a sexually transmitted disease in the past.

What are the symptoms?

CIN usually does not cause symptoms. Sometimes it causes bleeding during or after sexual intercourse or a change in your vaginal discharge.

How is it diagnosed?

CIN is diagnosed by a simple, painless test called a Pap test. To do a Pap test, your healthcare provider places the end of a thin speculum into your vagina to see your cervix. Your healthcare provider then gently collects cells from your cervix and cervical canal. Cells from the cervix are sent to a lab to be viewed under a microscope.

If a closer look at your cervix is needed, you may have a colposcopy. For this procedure a colposcope (an instrument with a magnifying lens) is used to look into your vagina with the speculum in place to see the cervix. Your provider may then wipe the cervix with a vinegar-like liquid to see the cells better. Small samples of any tissue that appears abnormal may be removed and sent to the lab for tests. The removal of this sample is called a biopsy.

How is it treated?

CIN may need to be treated to try to help stop it from becoming cervical cancer. The specific treatment may depend on whether the CIN is mild, moderate, or severe.

Mild cervical intraepithelial neoplasia, also called CIN 1, usually goes away without treatment. If you have CIN 1, your healthcare provider will probably want to do another Pap test in 4 to 6 months, and possibly a colposcopy. If the Pap test still shows CIN, your healthcare provider may recommend a colposcopy and biopsy.

If you have moderate cervical intraepithelial neoplasia, called CIN 2, your provider may follow you closely with another Pap smear and colposcopy in 4 to 6 months or remove the abnormal tissue. The abnormal tissue can also be removed with a thin wire loop attached to an electrical unit. This is called the loop electrosurgical excisional procedure (LEEP). Laser may also be used to remove the abnormal tissue. You do not have to stay in the hospital for any of these procedures. They can be done in your provider's office.

For severe cervical intraepithelial neoplasia, called CIN 3, your provider will do a cone biopsy, which is the removal of a cone-shaped piece of the cervix. This procedure is also called conization of the cervix. It removes the tissue containing abnormal cells. Your provider can cut the tissue out with a surgical knife, laser, or wire loop (LEEP). If the procedure is done with a knife or laser, it is usually done in an operating room. The tissue removed is examined in the lab to check for cancer.

Very few women have trouble getting pregnant or have miscarriages as a result of any of these treatments, including cone biopsies. If you become pregnant and have had a cone biopsy, tell your prenatal care provider about it. Most women who have had a cone biopsy are able to become pregnant and carry the baby to term without problems.

How can I take care of myself?

After a Pap test that shows CIN, follow your healthcare provider's advice for treatment and checkups. Your provider may recommend that you have a Pap test at least twice a year for the next 2 to 3 years. This will allow your provider to detect any recurrence of CIN and treat it promptly. Then, if your Pap tests have been normal, you may need the test just once a year. Continue to have Pap tests after a hysterectomy as recommended by your healthcare provider.

How can I help prevent cervical intraepithelial neoplasia?

To lower your risk of CIN:

• Try to avoid exposure to HPV. Do not have more than 1 sexual partner. It will also help if your partner has not been sexually active with anyone else. Find out your partner has had any sexually transmitted diseases. You can get some protection from HPV by using latex or polyurethane condoms every time you have sexual intercourse. However, condoms do not completely protect against this infection, which can be spread from other parts of the body.
• Avoid sexual intercourse until you are 18 or older.
• Do not smoke. Avoid breathing smoke from other people's cigarettes.